title: Hyper-CVAD regimen in routine management of adult acute lymphoblastic leukemia: a retrospective multicenter study.
abstract: Treatment of acute lymphoblastic leukemia is unsatisfactory in adults due to disease and patient-related factors and probably because adult chemotherapy regimens are weaker than pediatric protocols. Worries about inadequacy of adult regimens urged many hematologists, including us, to reconsider their routine treatment practices. In this retrospective multicenter study, we aimed to evaluate results of hyper-CVAD treatment in comparison to other intensive protocols. All patients aged ≤65 years who were commenced on intensive induction chemotherapy between 1999 and 2011 were included in the study. Sixty-eight of 166 patients received hyper-CVAD, 65 were treated with CALGB-8811 regimen and 33 with multiple other protocols. Limited number of patients who were treated with other intensive protocols and mature B-acute lymphoblastic leukemia cases who were mostly given hyper-CVAD were eliminated from the statistical analyses. In spite of a favorable complete remission rate (84.2%), overall (26.3 vs. 44.2% at 5 years, p = 0.05) and disease-free (24.9 vs. 48.2%, p = 0.001) survival rates were inferior with hyper-CVAD compared to CALGB-8811 due to higher cumulative nonrelapse mortality risk (29.7 vs. 5.9%, p = 0.003) and no superiority in cumulative relapse incidence comparison (45% for both arms, p = 0.44). Hyper-CVAD, in its original form, was a less favorable regimen in our practice.
authors.affiliation: Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Buyukasik
authors.forename: Kadir
authors.initials: K
authors.lastname: Acar
authors.forename: Engin
authors.initials: E
authors.lastname: Kelkitli
authors.forename: Burak
authors.initials: B
authors.lastname: Uz
authors.forename: Songul
authors.initials: S
authors.lastname: Serefhanoglu
authors.forename: Evren
authors.initials: E
authors.lastname: Ozdemir
authors.forename: Merve
authors.initials: M
authors.lastname: Pamukcuoglu
authors.forename: Hilmi
authors.initials: H
authors.lastname: Atay
authors.forename: Ozlen
authors.initials: O
authors.lastname: Bektas
authors.forename: Gulsan Turkoz
authors.initials: GT
authors.lastname: Sucak
authors.forename: Mehmet
authors.initials: M
authors.lastname: Turgut
authors.forename: Salih
authors.initials: S
authors.lastname: Aksu
authors.forename: Munci
authors.initials: M
authors.lastname: Yagci
authors.forename: Nilgun
authors.initials: N
authors.lastname: Sayınalp
authors.forename: Osman I
authors.initials: OI
authors.lastname: Ozcebe
authors.forename: Hakan
authors.initials: H
authors.lastname: Goker
authors.forename: Ibrahim C
authors.initials: IC
authors.lastname: Haznedaroglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide